Medicare to Pay Doctors for Chronic Care Management

2015 will bring some well-deserved additional reimbursement for primary care physicians and other providers that manage some of the most difficult patients in the healthcare system: those with multiple chronic illnesses.

Beginning in 2015, Medicare is going to begin to make separate, monthly payments to physicians for chronic care management (CCM) services. These services include all of the non-face-to-face work that PCP’s put in to help develop and revise plans of care, communicate with the patient’s other physicians, and manage patient’s medications. The code for these services – which we have yet to see released – will be reimbursed at a rate near $41.92, which can be billed once per month per qualified patient.

This news received attention a few days ago in the New York Times article “Medicare to Start Paying Doctors Who Coordinate Needs of Chronically Ill Patients.”

The below excerpt comes directly from a CMS fact sheet, published July 3, 2014:

Medicare continues to emphasize primary care management services by beginning to make separate payment for chronic care management (CCM) services beginning in 2015. In last year’s final rule, we established policy to make separate payment for non-face-to-face chronic care management services for Medicare beneficiaries who have multiple, significant chronic conditions (two or more). Chronic care management services include regular development and revision of a plan of care, communication with other treating health professionals, and medication management.

This proposed rule addresses three aspects of CCM services. We propose a payment rate of $41.92 for the code that can be billed no more frequently than once per month per qualified patient. We also propose to allow greater flexibility in the supervision of clinical staff providing CCM services. Finally, we are not proposing to establish separate standards that practitioners and practices furnishing this service would have to meet, as we had indicated last year. Upon further review, we believe the scope of service requirements for CCM, most of which were finalized last year, would be sufficient for practitioners to deliver CCM. We are proposing one additional requirement – standards for electronic health records – and seek comment on whether additional standards are needed. Payment for CCM is only one part of a multi-faceted CMS initiative to improve Medicare beneficiaries’ access to primary care. Models being tested through the Innovation Center will continue to explore other primary care innovations.